Provider Demographics
NPI:1790851442
Name:FRID, ALEXANDER BORIS (DO)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:BORIS
Last Name:FRID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 N PALM CANYON DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4414
Mailing Address - Country:US
Mailing Address - Phone:760-325-6530
Mailing Address - Fax:760-325-7866
Practice Address - Street 1:1100 N PALM CANYON DR
Practice Address - Street 2:SUITE 111
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4414
Practice Address - Country:US
Practice Address - Phone:760-325-6530
Practice Address - Fax:760-325-7866
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6891207Q00000X, 207QA0505X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG79803Medicare UPIN
CA020A68910Medicare ID - Type Unspecified